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Biomedical subjects

E Frank

Publications and source records attributed to E Frank.

At least 235 records · Page 13Linked to original sources
PubMed1995

Complicated grief and bereavement-related depression as distinct disorders: preliminary empirical validation in elderly bereaved spouses.

OBJECTIVE: This study sought to determine whether a set of symptoms interpreted as complicated grief could be identified and distinguished from bereavement-related depression and whether the presence of complicated grief would predict enduring functional impairments. METHOD: Data were derived from a study group of 82 recently widowed elderly individuals recruited for an investigation of physiological changes in bereaved persons. Baseline data were collected 3-6 months after the deaths of the subjects' spouses, and follow-up data were collected from 56 of the subjects 18 months after the baseline assessments. Candidate items for assessing complicated grief came from a variety of scales used to evaluate emotional functioning (e.g., the Hamilton Depression Rating Scale, the Brief Symptom Inventory). The outcome variables measured were global functioning, medical illness burden, sleep, mood, self-esteem, and anxiety. RESULTS: A principal-components analysis conducted on intake data (N = 82) revealed a complicated grief factor and a bereavement-depression factor. Seven symptoms constituted complicated grief: searching, yearning, preoccupation with thoughts of the deceased, crying, disbelief regarding the death, feeling stunned by the death, and lack of acceptance of the death. Baseline complicated grief scores were significantly associated with impairments in global functioning, mood, sleep, and self-esteem in the 56 subjects available for follow-up. CONCLUSIONS: The symptoms of complicated grief may be distinct from depressive symptoms and appear to be associated with enduring functional impairments. The symptoms of complicated grief, therefore, appear to define a unique disorder deserving of specialized treatment.

Age Factors↗
PubMed1995

REM sleep enhancement by bupropion in depressed men.

OBJECTIVE: The authors compared the effects of bupropion, fluoxetine, and cognitive behavior therapy on EEG sleep in depressed subjects. METHOD: All-night sleep EEG studies were performed before treatment and after partial or full remission on 18 men with depression diagnosed according to Research Diagnostic Criteria and randomly assigned to treatment with either bupropion (N = 7) or fluoxetine (N = 11). Response to these drugs was measured by changes in Hamilton Depression Rating Scale scores. Pre- and posttreatment EEG sleep study results before and after treatment with cognitive behavior therapy were also available for 18 men matched in age and severity of Hamilton depression scale score, and one-time EEG sleep measures were available for 36 men who were not depressed. RESULTS: REM latency was reduced and REM sleep percent and REM time increased after treatment in the depressed men given bupropion. These effects contrasted with the effects of fluoxetine and cognitive behavior therapy. CONCLUSIONS: This study represents the first report of an antidepressant medication that shortens REM latency and increases REM sleep. If confirmed, this finding may require a revision of our current understanding of the relation among depression, REM sleep, and anti-depressant mechanisms.

Adult↗
PubMed1995

Muscle sensory neurons require neurotrophin-3 from peripheral tissues during the period of normal cell death.

To determine if muscle sensory neurons require neurotrophin-3 (NT3) during the period of normal cell death, we used an NT3-specific antiserum to deplete NT3 from peripheral tissues during this period in chick embryos. DiI staining of dorsal roots indicated that limb injections of anti-NT3 reduced the spinal projection of muscle spindle afferents. In contrast, injection of the antiserum into the spinal cord had no demonstrable effect, indicating that the reduced projection following limb injection was due to peripheral blockade of NT3 signaling. Counts of neurons retrogradely labeled from muscle and cutaneous nerves showed that peripheral blockade of NT3 selectively reduced the survival of muscle sensory neurons without affecting the survival of cutaneous sensory neurons or motoneurons. In situ hybridization with trkC probes indicated that, during the period of cell death, most large diameter muscle sensory neurons express trkC transcripts, whereas few cutaneous neurons express this receptor for NT3. We conclude that large diameter muscle afferents, including spindle afferents, require NT3 from peripheral tissues to survive the normal period of sensory neuron death in vivo.

Animals↗
PubMed1995

The nicotinic blocking agents d-tubocurare and alpha-bungarotoxin save motoneurons from naturally occurring death in the absence of neuromuscular blockade.

Motoneurons undergo a phase of target-dependent cell death during development. In chick embryos, motoneuronal death is blocked by the application of the nicotinic antagonists d-tubocurare (dTC) or alpha-bungarotoxin (alpha BTX). Paralytic doses of these drugs also increase intramuscular nerve branch formation. To investigate the possibility that a neuronal rather than a muscle-type nicotinic ACh receptor (nAChR) might be responsible for the toxin-induced arrest of naturally occurring motoneuronal death, we compared the doses of dTC and alpha-BTX required for paralysis with those needed to protect motoneurons from cell death. We also measured the effects of dTC on the survival of retrogradely labeled motoneurons in culture, and of various doses of dTC on intramuscular nerve branch formation. Subparalytic doses of dTC caused small but significant increases in nerve branch number, while higher doses produced larger effects. In contrast, motoneuronal survival was already maximal at doses of dTC or alpha-BTX below those needed for a visible effect on limb movement. Moreover, dTC increased motoneuron survival in culture, in the absence of muscle cells and muscle-type nAChRs. Nicotinic blocking agents can therefore rescue motoneurons with minimal depression of neuromuscular transmission, suggesting that this effect may be mediated through neuronal, rather than muscle-type.

Animals↗
PubMed1995

Alliance not compliance: a philosophy of outpatient care.

Over the last decade, our clinical research team has evolved effective methods for forming a strong treatment alliance with mood disorder patients. These methods, in turn, have been associated with very low rates of patient dropout (< 10%) and high rates of objectively measured medication compliance (> 85%) over multiyear treatment trials. We have every reason to believe that our technique for alliance building would be equally effective in general clinical practice. The cornerstones of our methods are education of, information for, and active participation by the patient in the treatment process. We begin by educating the patient about his or her disorder and its treatment, giving patients as much information as their clinical condition will allow them to absorb. As patients begin to improve, we provide additional information. We continuously inform patients about what to expect in treatment and when, both with respect to amelioration of symptoms and with respect to the medication side effects they may experience. We present the treatment experience as an experiment in which clinician and patient are coinvestigators, each with his or her own expertise. The clinician is the expert on the disorder and its treatment in general; the patient is the expert on his or her own disorder and his or her own experience of the treatment. We try to keep the experiment interesting and, whenever possible, to inject some humor into it. We work to engage family members as adjunct members of the experimental team by educating them as well and keeping them informed throughout the treatment process.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗
PubMed1995

Peripheral target specification of synaptic connectivity of muscle spindle sensory neurons with spinal motoneurons.

The source of environmental cues determining the central connections of muscle sensory neurons was investigated by manipulating chick embryos so that sensory neurons supplied a duplicate set of dorsal thigh muscles. These neurons projected out ventral nerve pathways and along motor axons that normally project to ventral muscles but their ultimate target tissue was the duplicate set of dorsal muscles. The central connections of these sensory neurons to motoneurons supplying normal dorsal muscles were then determined with intracellular recordings in isolated spinal cord preparations. Sensory neurons supplying individual duplicate dorsal muscles made the same connections as those supplying the corresponding normal dorsal muscles; the pattern of these connections was different than that made by afferents supplying ventral muscles. Sensory neurons thus made synaptic connections appropriate for their target muscle rather than for their more proximal ventral environment. These findings suggest that the target muscle is the source of cues that determine the central connections of the sensory neurons projecting to it. Motoneurons forced to innervate novel muscle received many of the same sensory inputs they would normally receive, suggesting that motoneurons are less influenced by their target tissue than sensory neurons.

Animals↗
PubMed1994

Authors' criteria for selecting journals.

OBJECTIVE: To evaluate authors' methods of selecting the journals to which they submit manuscripts. DESIGN AND SETTING: In 1992, all of the active clinical and research faculty of Stanford University School of Medicine (n = 479), Palo Alto, Calif, were sent up to three mailings of a one-page questionnaire. RESULTS: Our response rate was 63.7% (n = 305). On a scale of 1 (unimportant) to 6 (very important), respondents ranked factors affecting initial manuscript submission to a journal in the following descending order (mean values are reported): the journal's prestige, 5.2; the makeup of the journal's readership, 4.8; whether the journal usually publishes articles on the topic, 4.8; the likelihood of manuscript acceptance, 4.4; the size of journal circulation, 4.1; the rapidity of manuscript turnaround, 4.1; the existence of good editors, 3.9; the likelihood of useful reviewer suggestions, 3.4; a history of having published in that journal previously, 3.4; colleagues' recommendations, 3.1; the likelihood of useful biostatistical suggestions, 2.6; the existence of editors who are personally known to the author, 2.1; and the likelihood of press attention, 1.9. For subsequent submissions, the most important factors were the likelihood of manuscript acceptance (5.0) and whether the journal usually publishes articles on the topic (4.7). CONCLUSIONS: Journal prestige, most frequently published journal topics, and readership composition were the most important factors for initial manuscript submissions. For subsequent submissions, more pragmatic variables, such as likelihood of acceptance, gained importance. These findings should help editors make their journals more attractive to potential authors.

Authorship↗
PubMed1994

Persistent effects of antidepressants: EEG sleep studies in depressed patients during maintenance treatment.

Electroencephalographic (EEG) sleep studies represent a research tool that can be used to examine depressed patients over different phases of their illness. We examined the long-term effects of imipramine on EEG sleep in 27 subjects who completed 3 years of maintenance treatment on imipramine without experiencing a recurrence. The analyses were performed on EEG sleep data collected prior to acute treatment, after 3 months in maintenance, and every 3 months thereafter. The major aim was to examine specific changes in rapid eye movement (REM) and slow-wave sleep (SWS) as they unfolded over the course of illness and recovery during long-term drug maintenance. The acute changes in the sleep profile produced by antidepressants remained essentially the same throughout the entire period of drug administration. The REM sleep parameters, which were affected immediately, remained essentially unchanged thereafter, even as long as 3 years into maintenance treatment. A rapid redistribution of slow-wave sleep in the first part of the night was also observed without an increase in the total amount of slow-wave sleep throughout the night. The application of spectral analysis confirmed that the sleep changes following drug administration remained stable throughout all phases of drug treatment. Thus, it appears that sustained clinical improvement is accompanied by persistent sleep alterations on tricyclic antidepressant medication.

Adult↗
PubMed1994

Life events and the research diagnostic criteria endogenous subtype. A confirmation of the distinction using the Bedford College methods.

BACKGROUND: Despite the advances in biological and psychosocial assessment methods, reliable distinction between depressed patients with endogenous presentations or melancholic symptom features and those with nonendogenous presentations has remained elusive. METHODS: Ninety patients with histories of frequent unipolar episodes classified as endogenous or nonendogenous by the Research Diagnostic Criteria were interviewed with the Bedford College Life Events and Difficulties Schedule regarding the 6 months before onset of their most recent episode of depression. RESULTS: Patients meeting the Research Diagnostic Criteria for definite endogenous subtype differed significantly from patients with nonendogenous features in terms of the proportion experiencing severe life stress in the 6 months before onset of their depressive episode (P < = .04). Furthermore, survival analysis revealed a closer temporal association between severe event and depression onset among patients with nonendogenous features (P < .02). CONCLUSION: Even among patients with a history of multiple recurrences of depression, psychological stress plays an important role in the timing of onset of episodes characterized by nonendogenous features.

Adaptation, Psychological↗
PubMed1994

Social rhythm in anxiety disorder patients.

UNLABELLED: The social rhythm metric (SRM) is a self report diary instrument which generates a numerical measure of rhythmicity of daily life behaviors. Depression researchers have proposed that life events cause disruption of social rhythmicity and this leads to disturbance in the sense of well-being and to disruption of physiologic rhythmicity known to be related to depressive episodes. We hypothesized that low rhythmicity of daily activities might also be characteristic of anxiety disorder patients. SUBJECTS: Forty-eight patients who met DSM III-R criteria for an anxiety disorder were recruited and compared with 41 previously monitored normal controls. PROCEDURES: All patients and controls completed at least two weeks of daily monitoring with the SRM. Anxiety patients underwent structured diagnostic assessment and completed demographic and clinical rating scales. SRM was analyzed according to a previously developed algorithm. RESULTS: Anxiety disorder patients report significantly lower regularity of daily activities than normal controls. The low SRM scores were not accounted for by the presence of comorbid affective disorder. CONCLUSIONS: We identify a new type of abnormality in anxiety disorder patients which has potential clinical as well as theoretical interest.

Activities of Daily Living↗
PubMed1994

Specific regeneration of cutaneous sensory afferent fibers in the amphibian spinal cord.

Regeneration of cutaneous sensory fibers within the spinal cord was studied in frogs after lesions of sensory axons in dorsal roots. Sensory fibers were disrupted by repeatedly freezing the exposed brachial dorsal root in postmetamorphic frogs. Previous experiments indicated that this procedure destroyed virtually all sensory axons within the dorsal root. The pattern of regrowth of these fibers within the spinal cord was then assessed at different times by labeling them with horseradish peroxidase applied to the superior cutaneous ulnar nerve in the front leg. Arborizations of cutaneous axons within the spinal gray matter were remarkably similar to those in normal frogs. The arborizations were restricted to dorsal levels of the cord, never projecting ventrally to the region where muscle spindle sensory axons terminate. These experiments complement earlier studies demonstrating that muscle spindle afferents also regenerate specifically. Together these studies indicate that sufficient cues exist in the mature amphibian spinal cord to allow different classes of sensory fibers to reinnervate their appropriate target areas.

Animals↗
PubMed1994

Nocturnal and circadian body temperatures of depressed outpatients during symptomatic and recovered states.

Forty-one recurrent unipolar depressed outpatients were studied at baseline (symptomatic period) and at recovery. Rectal temperatures were measured continuously between 1800h and 0600h on 2 successive nights at each time point. In those 24 patients who recovered after receiving interpersonal psychotherapy (IPT) alone ("psychotherapy responders") and who thus remained drug-free throughout, there was no difference in nocturnal body temperatures between baseline and recovery time points. Moreover, nocturnal temperature patterns appeared to be very similar to those of a healthy contrast group (n = 17). The contrast group was not matched for age and gender with the patient group, though, so the comparison was only suggestive. At baseline, those recovering after psychotherapy alone (n = 24) did not differ from those eventually failing to respond to IPT and requiring medications to achieve recovery ("medication responders") (n = 17). Medication responders did show some baseline versus recovery differences in nocturnal temperatures, but these may possibly have been a function of the medications used. At recovery, a subset of 19 psychotherapy responders and 13 medication responders underwent an "unmasking" experiment involving 36 hours of wakeful bedrest. In the resulting endogenous temperature rhythms, there was no evidence of any reliable differences between the psychotherapy responder and medication responder patient groups. Both groups showed rhythms that were very similar to those of a healthy contrast group (n = 17), although, again, the contrast group was not matched for age or gender with the patient group. In conclusion, in measures of body temperature, at least, there appeared to be little evidence of circadian dysfunction in this group of recurrent outpatient depressives.

Adult↗
PubMed1994

Stressful life events, social rhythms, and depressive symptoms among the elderly: an examination of hypothesized causal linkages.

This study sought to determine possible causal linkages among stressful life events, social rhythms, and levels of depressive symptomatology for 81 elderly subjects (51 recently widowed, 30 healthy controls). We examined the associations among stressful life events (i.e., bereavement status at baseline or a severely threatening event occurring between baseline and followup), social rhythm stability, and the level of depressive symptoms. Results indicated that while stressful life events were not associated with significant changes in social rhythm stability, social rhythm stability was a significant negative correlate of both baseline and followup levels of depressive symptomatology; that is, lower levels of social rhythm stability at baseline were associated with high levels of depressive symptoms at baseline (rho = -0.33, n = 81, p < 0.001) and at followup (rho = -0.23, n = 81, p < 0.05). Bereavement was also a significant positive correlate of depressive symptomatology both at baseline (rho = 0.79, n = 81), p < 0.0001) and at followup (rho = 0.55, n = 81, p < 0.0001). It is likely that future research will benefit from social rhythm assessment obtained temporally closer to major life events and from the use of structured interviews to ascertain the presence of syndromal major depression at followup as well as the inclusion of subjects with a wider range of functional impairments. Nevertheless, these results represent a first step in disentangling possible causal connections among stressful life events, social rhythms, and depressive symptomatology.

Aged↗
PubMed1994

Affect intensity and phasic REM sleep in depressed men before and after treatment with cognitive-behavioral therapy.

This article explored the relationship between daytime affect and REM sleep in 45 depressed men before and after treatment with cognitive-behavioral therapy and in a control group of 43 healthy subjects. The intensity of daytime affect (as measured by the sum of positive and negative affects) in depressed men correlated significantly and positively with phasic REM sleep measures at both pre- and posttreatment. This relationship was not found in healthy control subjects. In depressed men, both affect intensity and phasic REM sleep measures decreased over the course of treatment. The results suggest a relationship between phasic REM sleep and intensity of affect reported by depressed men. On the basis of this preliminary observation, it was hypothesized that abnormalities in phasic REM sleep in depressed patients are related, in part, to fundamental alterations in the intensity of their affective experience.

Adult↗
PubMed1994

Imipramine and sexual dysfunction during the long-term treatment of recurrent depression.

Ninety patients in the maintenance therapy phase of the Pittsburgh Study of Maintenance Therapies in Recurrent Depression (Frank et al., 1990) were studied to determine possible relationships between the type of therapy (imipramine versus no drug) and the level of sexual functioning. The level of sexual functioning was determined by a composite subscale score of the Social Adjustment Scale which assessed (1) current level of enjoyment and interest in sex; (2) change in interest; (3) current frequency of sexual intercourse; (4) change in frequency; and (5) pain and/or difficulty reaching orgasm. Loss of libido was assessed by both the Hamilton Rating Scale for Depression and the SCL-90. Logistic regression analysis revealed no relationship between treatment with active imipramine and sexual functioning for the total group, or for females alone. Analysis of males alone revealed a decreased interest in sex among those treated with imipramine, but no significant differences in frequency or problems. The implications for maintenance pharmacotherapy and the cost/benefit ratio of unacceptable side effects versus drug efficacy are discussed.

Adult↗
PubMed1994

The effect of position on magnetic resonance evaluation of cerebrospinal fluid shunt function.

Since cerebrospinal fluid shunt malfunction is common and its diagnosis often requires invasive testing, we have evaluated magnetic resonance imaging (MRI) as a noninvasive test for shunt function. In prior experiments, MRI has been shown to be capable of detecting flows as low as 0.4 cc h-1 in shunt systems. Because patient movement and position in an MRI scanner are variable, we have studied the effects of shunt position on the ability to reliably detect the rate of CSF flow. Flow related enhancement of fluid flowing from 0 to 2 cc h-1 was measured in a specialized section of tubing using multiple spin echo scans (TR2000,TE20). The angle of the specialized tubing was varied relative to the axis of the MRI scanner and then the intensity of the MR signal at specific points in the tubing was measured at different flow rates. No flow standards were used as controls. The results show that the linear relationship between signal intensity and flow that had previously been demonstrated was significantly altered by changes of position. Positions angled superior to the axis of the scanner enhanced the signal while lateral changes in the plane of the scan degraded the signal. These results suggest that in order for MRI to become an accurate test for shunt function, techniques must be developed to overcome the effects of shunt position.

Cerebrospinal Fluid Shunts↗
PubMed1994

The accuracy of anterior-posterior measurements in the assessment of spinal canal compromise in burst fractures.

The amount of spinal canal compromise is one of the primary criteria employed to specify treatment of thoracolumbar burst fractures. Canal compromise has been calculated utilizing measurement of anterior-posterior canal or by calculating the area of the involved spinal canal on CT scans. Since these measurements are critical to surgical decision making, we have compared anterior-posterior measurements with area measurements to assess the variability between these two techniques. Three mm axial CT scans from ten patients with thoracolumbar burst fractures were studied. The axial CT images at the midpoints of the vertebral bodies at the levels above and below the fracture level, and the axial CT image demonstrating the most significant canal compromise at the fracture level were digitized using an optical scanner. Using the image 1.43 software, the anterior-posterior dimensions and area dimensions of each axial CT scan were obtained and the amount of canal compromise calculated. Linear measurements consistently overestimate the extent of spinal canal compromise as compared to the true area of canal compromise (6-46%, p < 0.005). This amount of variation did not correlate with the level, patient age or the extent of canal compromise. This preliminary study suggests that the two measurement techniques used to guide surgical decision making are not comparable. Further evaluation comparing the use of linear and area measurements is warranted.

Humans↗